Cancer specialist queries value of national breast cancer screening program

A senior Sydney cancer specialist has questioned the value of routine testing for breast cancer under the national breast screening program.

Each year 1,500,000 women subject themselves to a mammogram, an often uncomfortable and painful experience.

Professor Alexandra Barratt from the University of Sydney's School of Public Health says the routine screening program is leading to over-diagnosis, where slow-growing, harmless breast cancers are treated, despite risky side effects.

BreastScreen Australia reports that deaths have reduced by 25 per cent over the last 20 years.

However, Professor Barratt says there is increasing evidence that it is advances in treatment rather than screening that saves lives.

"What's not clear is whether screening still delivers that benefit, now that we've got such advances in treatment, and whether there's still an additional benefit to be gained by running a screening program in the same way that was when they were set up," she said.

"Other studies that are coming out are saying actually it looks like it's treatment that's delivering the benefit, and screening is playing only a small part in the decline in breast cancer death rates that we are seeing around the world in western countries."

She says cancer treatment such as surgery, radiotherapy and chemotherapy do have side effects and carry risk.

"While you would certainly want those treatments for a cancer that was destined to harm you and potentially be life threatening, you wouldn't want them for a cancer that is just going to remain dormant and indolent and never cause any symptoms," she said.

"That's unfortunately an inherent downside of mammography screening - that it can detect these cancers that either won't progress, or will progress so slowly that they would never cause any bother in the woman's lifetime."

Fears that comments may discourage breast checks

But Professor Barratt's position is rejected by Professor John Boyages, director and professor of breast oncology at the Macquarie University Cancer Institute.

He says it is dangerous to be sending a negative message that screening is not playing an effective role in fighting breast cancer.

"I think Professor Barratt's comments cause confusion, it often means people working two jobs, looking after children and trying to find time to have a breast X-ray may think twice about having it," he said.

"And I think it sends a negative message that our treatments are wonderful, and can kill breast cancer.

"The best way of treating breast cancer, making sure you can save your breast, less chance of having chemotherapy, less chance of having all the glands under your armpits removed, and dealing with dreadful side affects... is to find it early. It's not rocket science."

Barratt calls for fresh randomised trial of modern screening

Professor Boyages fears that if women hear a message that routine screening is unnecessary, some may not seek treatment until it is too late.

"You can't just say treatment is wonderful and it's going to ... let women appear like they did when I first started with big rockmelon cancers in their breast, with bleeding cancers," he said.

"I don't want to go back to those days where every second patient we had to lop her breast off."

Professor Barratt says there is no risk of going backwards in breast cancer detection, but it is time to look at a fresh randomised trial evaluating the effectiveness of Australia's breast screening program.

"What we really need is some gold standard evidence, and that means doing more randomised trials, doing new randomised trials," she said.

"The first randomised trial of breast cancer screening was actually conducted 50 years ago, so the data, although it is good quality, is old.